Trump’s latest health care move squeezes Republicans

Sen. Susan Collins of Maine — one of three GOP senators who blocked the Obamacare repeal effort last year — warned the administration's new bid could undermine key patient protections. | John Shinkle/POLITICO

Republicans who have tried to repeal Obamacare for nearly a decade believe the Trump administration is reviving a politically risky battle with a court filing that could eliminate one of the most popular parts of the law: protections for people with pre-existing conditions.

The administration wants a federal court to strike the protections, providing fresh fodder to Democrats who argue that the GOP cannot be trusted to protect Americans’ health insurance months ahead of a midterm election in which health care was already a top issue. It also threatens to shift attention away from the GOP's message on tax cuts, refocusing it on an Obamacare fight most Republicans wanted to put behind them.

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The administration late Thursday asked a U.S. District Court in Texas to do something congressional Republicans weren’t willing to take on themselves during last year’s repeal effort: Strike the most popular part of Obamacare.

Few congressional Republicans rushed to defend the administration's move Friday, instead emphasizing their support for preserving pre-existing condition protections.

“I’m not going to have to defend anything I don’t agree with — regardless of who says it,” said Rep. Phil Roe of Tennessee when asked if he would defend the administration’s request on the campaign trail this fall. He added that rising premiums for Obamacare coveragewill force lawmakers to address health care policy next year.

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Sen. Susan Collins of Maine — one of three GOP senators who blocked the Obamacare repeal effort last year — also pushed back, warning the administration's new bid “exacerbates our current challenges” and could undermine key patient protections.

Other lawmakers pointed to past support for policies to prevent insurance companies from denying or dropping people with pre-existing conditions.

In 2017, “I introduced [an amendment that] would guarantee coverage for pre-existing conditions. I think that’s a pretty essential pact with the American people,” said Rep. Tom MacArthur (R-N.J.). “We need to let them go forward and see if it goes anywhere. Right now they’ve simply made an appeal to the court.”

And several Republicans dodged questions on the subject, saying they were unfamiliar with the legal request.

“I want to think about it before I respond,” said Rep. Fred Upton (R-Mich.).

Senate Democrats, who this week promised to force votes on health care during August, said the court filing proves their warnings that Republicans remain intent on repealing Obamacare through any means available.

“I’ve decided not to be surprised about anything this administration does,” said Sen. Chris Murphy (D-Conn.). “It’s our job to make sure everybody knows who’s responsible for that, so that they can hold Republicans responsible at the polls this November.”

Within hours of the news,Democrats pounced on the Senate Republicans up for reelection this fall. The Democratic Senatorial Campaign Committee blasted releases questioning whetherthose Republicans — such as North Dakota hopeful Rep. Kevin Cramer —back the Trump administration’s decision.

Murphy dismissed Republicans' efforts to distance themselves from the administration’s legal position, arguing that it was the GOP that fueled the case by repealing Obamacare’s individual mandate.

“Republicans and the Trump administration are working hand in hand,” he said.

During last year's repeal debate, Republicans decided to leave pre-existing conditions protections in place after they repeatedly became the subject of sometimes fiery town hall meetings with constituents.

The legal move Thursdaythreatens to revive those tensions and overshadow positive messages about Republican policies such as tax cuts.

“It just blows me away how dumb it is,” said GOP consultant Rick Wilson. “They really wanted to spend this summer saying the tax bill’s great, the economy’s great. But they go off the rails at every opportunity, and it just slays me.”

Texas and several Republican-led states brought the Obamacare challenge, arguing that the elimination of individual mandate penalties — which the Supreme Court ruled in 2012 were valid under Congress’s taxing power — invalidated the constitutionality of all of Obamacare. The Trump administration said it agreed that the mandate was unconstitutional and that the consumer protections should be wiped out, but most of the rest of the law should remain in place.

Some Republicans privately worried about having to defend the move in their districts if the court rules in favor of the administration before the November election. But others said the government needs to get out of the health insurance business — even if the only way is to go through the courts.

“It isn’t [hard] for me because I’ve long held the position that the federal government should get completely out of the health insurance business,” said Rep. Steve King (R-Iowa). “The last time the health insurance business worked right was before the federal government got involved. So I don’t have any problem going home to defend that.”

Establishment Republicans trying to move beyond the Obamacare repeal failure remain at odds with conservatives intent on pressing on, arguing that the 2019 premium hikes should force the GOP to act.

“It’s a campaign promise. You’ve got to deliver on it in whatever way you can,” said Jason Pye, vice president of legislative affairs for FreedomWorks. “They’re going to have an Obamacare debate whether they like it or not, because the new premiums are going to come out in September and October.”

He added that while tax cuts and the economy are winning issues for Republicans, they’re not nearly enough to fire up conservative voters disillusioned by the party’s unwillingness to follow through on their pledge to eliminate Obamacare “root and branch.”

“This is better than nothing, and it’s certainly better than some of the replacement plans that we’ve seen,” Pye said of the administration’s legal move.

It is unclear how soon the U.S. District Court judge may respondto the administration's request. If the courts strike the provision, the ruling would all but certainly be appealed — likely by a group of Democratic-led states that have weighed in on the case in the courts.

Rep. Michael Burgess (R-Texas) said Republicans would be ready to act if the courts strike the protections.

“Maybe the silver lining to all of this is that if that all comes to pass, then something will have to happen,” he said. “It will require us to work together.”

Insurance companies have already requested double-digit premium increases for 2019 in several states. The industry has blamed Trump administration decisions to undermine the health law, such as cutting off a key subsidy program to help low-income people pay their out-of-pocket health expenses.

The insurance industry trade group America’s Health Insurance Plans swiftly broke with the Trump administration Friday, warning that eliminating Obamacare’s major protections would be “destabilizing” to the market and drive premiums even higher. AHIP signaled it will file an amicus brief in the case, officially siding with the blue states that have stepped in to defend the law’s constitutionality.

“Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” the group said in a statement.